Meniscus Injuries

Knees feel “stuck” or ”locked” 

What are meniscus injuries?

Menisci are cartilage pads that act as shock absorbers between the shin and thigh bones. These cartilages are pivotal in knee stability and distributing weight during mobility. Meniscus injuries can occur either on the medial (inner) or the lateral (outer) part of the knee and they manifest either as a tear or in extreme cases, a complete rupture.

Meniscus injuries are notably one of the more common forms of injuries to occur, with the number of cases steadily rising over the years. This may be attributed to the increased participation in extreme sports or the widespread improvement of physicians' ability to diagnose the condition accurately. 

Meniscus injuries are classified according to the extent of the tear which is visualised during diagnosis:

  • Grade 1: small tear in the inside of the meniscus, the injury has not extended to the surface.
  • Grade 2: a large tear but still on the inside of the meniscus. The outer layer is still intact.
  • Grade 3: the outer layer made up of fibrocartilage is torn. 
meniscus tear
Meniscus injuries can occur on the medial or the lateral part of the knee.

What causes meniscus injuries?

Meniscus injuries can be the result of intense trauma or merely a misstep. The source of injury at times is unpredictable. 

Some common causes of meniscus injuries include:

  • Improper movement: abruptly twisting the knee whilst the feet are planted flat on the ground could lead to a meniscus injury. These movement-based injuries are common among athletes. 
  • Awkward positioning: sudden tears from kneeling, deep squatting, and abruptly lifting heavy objects could also lead to meniscus injuries. 
  • Degeneration: structurally some patients face degeneration of the meniscal structure, making them vulnerable to meniscal tears. 
meniscus injury athletes
Improper movement such as abruptly swerving could lead to a meniscus injury.

What are the symptoms of meniscus injuries?

Meniscus injury symptoms tend to be quite similar to other types of knee injuries.

Some signs to look out for include: 

  • A loud “pop” or “snap” when an injury occurs 
  • Swollen knees
  • Pain that gradually worsens over time
  • Inability to smoothly bend and flex the knee
  • Knees feel “stuck” or ”locked” 
  • Sensation of your leg “giving away” or buckling
If you notice any of the symptoms, make an appointment with an orthopaedic specialist to get an accurate diagnosis and treatment.

Dr Puah KL is our Senior Consultant Orthopaedic Surgeon at Artisan Sports & Orthopaedic Surgery. He used to serve the sports service of Singapore General Hospital - the highest volume trauma centre for orthopaedics in Singapore.

Are meniscus injuries painful?

Generally, yes. Meniscus injuries can make one’s body weight difficult to bear as weight transmission is impacted.

Many tend to be able to withstand pain in the first few hours of injury, however, when their knees become “locked”, even the slightest movement can cause debilitating pain. One may observe localised pain at the centre and the sides of the knee accompanied by stiffness.

Who is at risk of meniscus injuries in Singapore?

There are some established patterns of risk for meniscus injuries. 

These include: 

  • Existing health conditions: individuals with arthritis and osteoarthritis tend to face rapid degeneration of the meniscus structure making them prone to meniscus injuries. Additionally, individuals with obesity also face risks of meniscus injuries as excess weight causes instability of the knee. 
  • Athletes: athletes of contact sports such as football and rugby tend to be susceptible to meniscus injuries. However, non-contact sports athletes such as volleyball players, are also prone to meniscus tears due to abrupt movements. 
  • Gender: men tend to be more prone to meniscus injuries due to the higher likelihood of participating in extreme sports and taking up greater heavy-bearing stresses. 
meniscus injury among men
Meniscus injuries tend to occur more commonly among men.

How are meniscus injuries diagnosed?

Meniscus injuries are diagnosed in the following ways: 

  • Physical examination and medical history: inform your orthopaedist of the potential activities that may have led to an injury such as trauma, exercise, or sports. Physically the area of injury will be examined as meniscus injuries tend to be palpable. Motion tests such as the McMurray test would be conducted to examine the response to twisting, bending, and flexing motions. 
  • Imaging tests: magnetic resonance imaging (MRI) are the gold standard in identifying meniscus tears. If deemed necessary, an ultrasound may be conducted to obtain a clear visualisation of soft-tissue swelling, collection of fluid, and to capture cartilage that might be stuck in the knee. An x-ray may be ordered if arthritis and osteoarthritis is suspected.
  • Diagnostic arthroscopy: arthroscopy would be ordered as a last resort if meniscus tears are evasive from the tests mentioned above. 

What are the treatment options for meniscus injuries in Singapore?

Depending on the severity and individual needs, different pathways of treatment would be employed. Typically, the objective for the treatment of meniscus injuries involves the preservation of the menisci. It is common that conservative treatment would be employed first. 

Treatment options for meniscus injuries include: 

  • Rest: you would be advised to observe complete rest to relieve pain and reduce swelling.
  • Medications: non-steroidal anti-inflammatory drugs (NSAIDs) and painkillers are commonly prescribed as the first course of treatment to reduce inflammation and manage pain. 
  • Injections: corticosteroid injections may be administered to provide relief from symptoms. 
  • Brace: to reduce movement of the joint and allow the menisci to heal.
  • Crutches: to limit placing weight on the affected knee.
  • Physiotherapy: upon discontinuation of the use of the brace, an active range of motion exercise would be administered via physiotherapy to regain mobility and strengthen the knee. Physiotherapy is usually key in the recovery of meniscus injuries. 
  • Surgery: knee arthroscopy surgery would be conducted if necessary. This would involve stitching up the tear or removing the damaged section of the meniscus. However, surgery would be considered based on the patient’s age and the orthopaedist’s assessment of the patient’s ability to heal. 
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